Review of compliance. Forest Care Limited Holly Lodge Nursing Home. South East. Region: St Catherine's Road Frimley Green Camberley Surrey GU16 9NP

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1 Review of compliance Forest Care Limited Holly Lodge Nursing Home Region: Location address: Type of service: South East St Catherine's Road Frimley Green Camberley Surrey GU16 9NP Care home service with nursing Date of Publication: January 2012 Overview of the service: Holly Lodge is owned by Forest Care Ltd. The service provides accommodation for up to 60 older people, some of whom have dementia. All bedrooms are for single occupation and have en-suite and washbasin facilities. The home has lounge areas on both floors which also serve as dining areas. Page 1 of 20

2 There are assisted bathrooms and showers and the home provides all necessary specialist equipment. A lift enables access to both floors of the home and there is a secure and accessible garden with a patio. Page 2 of 20

3 Summary of our findings for the essential standards of quality and safety Our current overall judgement Holly Lodge Nursing Home was meeting all the essential standards of quality and safety. The summary below describes why we carried out this review, what we found and any action required. Why we carried out this review We carried out this review as part of our routine schedule of planned reviews. How we carried out this review We reviewed all the information we hold about this provider, carried out a visit on 15 December 2011, observed how people were being cared for, talked to staff and talked to people who use services. What people told us People that we spoke to said they felt comfortable and settled at Holly Lodge. The registered manager was not available on the day of our visit therefore the service was represented by the registered provider and the head of care. What we found about the standards we reviewed and how well Holly Lodge Nursing Home was meeting them Outcome 01: People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run People were involved in the decisions about the care provided and their care and support was based on their individual needs and preferences. People using the service were treated with respect and their rights to privacy and dignity upheld. Outcome 04: People should get safe and appropriate care that meets their needs and supports their rights People using the service receive safe and consistent care and support to meet their individual health and welfare needs. Page 3 of 20

4 Outcome 07: People should be protected from abuse and staff should respect their human rights People who use the service are protected by a staff team that have received training to enable them to recognise and respond to safeguarding concerns. Outcome 09: People should be given the medicines they need when they need them, and in a safe way The service protects people against the risks associated with the unsafe use and management of medicines. Outcome 13: There should be enough members of staff to keep people safe and meet their health and welfare needs Staff work in an organised way to offer continuity of care to ensure the health, safety and welfare of people using the service. Outcome 16: The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care The provider has arrangements in place to ensure that people who use the service are safe. The quality of care provision is monitored and improvements made when concerns are raised. Other information Please see previous reports for more information about previous reviews. Page 4 of 20

5 What we found for each essential standard of quality and safety we reviewed Page 5 of 20

6 The following pages detail our findings and our regulatory judgement for each essential standard and outcome that we reviewed, linked to specific regulated activities where appropriate. We will have reached one of the following judgements for each essential standard. Compliant means that people who use services are experiencing the outcomes relating to the essential standard. A minor concern means that people who use services are safe but are not always experiencing the outcomes relating to this essential standard. A moderate concern means that people who use services are safe but are not always experiencing the outcomes relating to this essential standard and there is an impact on their health and wellbeing because of this. A major concern means that people who use services are not experiencing the outcomes relating to this essential standard and are not protected from unsafe or inappropriate care, treatment and support. Where we identify compliance, no further action is taken. Where we have concerns, the most appropriate action is taken to ensure that the necessary improvements are made. Where there are a number of concerns, we may look at them together to decide the level of action to take. More information about each of the outcomes can be found in the Guidance about compliance: Essential standards of quality and safety Page 6 of 20

7 Outcome 01: Respecting and involving people who use services What the outcome says This is what people who use services should expect. People who use services: * Understand the care, treatment and support choices available to them. * Can express their views, so far as they are able to do so, and are involved in making decisions about their care, treatment and support. * Have their privacy, dignity and independence respected. * Have their views and experiences taken into account in the way the service is provided and delivered. What we found The provider is compliant with Outcome 01: Respecting and involving people who use services Our findings What people who use the service experienced and told us We spoke with several people and they all said that they liked it at Holly Lodge. One person said that the staff was lovely and that they didn't have to do things they didn't want to do. Other evidence We saw examples of four comprehensive care plans which had been developed for each person using the service. They documented people's wishes and preferences in relation to how their care was provided, how they liked to spend their time and how they preferred to be supported. We saw that, where possible, people and their representatives had signed the care plans to confirm they were happy with them. During our visit we saw that people were being spoken with and supported in a sensitive, respectful and professional manner. We spoke with one person who said they did not want to have a bath and the staff member showed kindness in making sure that the person knew that they didn't have to have a bath if they didn't want to. We saw staff, on two separate occassions supporting a person who was distressed in a calm and reassuring manner. On one occasion it was evident that the person using the service knew and felt safe in the staff members company by their reponse to the Page 7 of 20

8 staff member who offered them assistance. When speaking with staff they were knowledgable about people's preferences and needs for example at coffee time where we saw that staff were at hand should people require support and assistance. We saw that some people had fortified drinks and the registered nurse told us that the homes chef was very vigilant in making sure people received a good diet and that people's diet was appropriate. It was confirmed that the service would make a referral to the speech and language therapist for a swallowing assessment if the need arose. We saw that some people were in their bedclothes during the morning and staff confirmed that they would be supported to dress if they wanted to. Staff stressed that the service was focussed on people's preferences and that if they did not want to get dressed they did not have to as long as their dignity and respect was upheld. The service has an activity coordinator and during our visit, people were involved in watching an aquaruim computer show and taking part in a planned karoke session. We saw that there was a variety of activities and rummage boxes, ornaments, objects, including a telephone box, and reminescent items for people to use in the home. The documented planned activities for people to attend were prominently displayed for people to see and we saw that people had taken part in a Christmas Carol concert, PAT dog visits and could recive Holy Communion if they wished. The environment was extremley clean, homely and well maintained and bold signage and photos of people were on their bedroom doors throughout the service to assist people to orientate themselevs. In addition memory boxes were secured outside people's individual bedrooms. The boxes contained photos of the person or their family members, pets, and friends and items of nostalgia or objects to help people's memories were also enclosed in the boxes. People were involved in the decisions about the care provided and their care and support was based on their individual needs and preferences. People using the service were treated with respect and their rights to privacy and dignity upheld. Page 8 of 20

9 Outcome 04: Care and welfare of people who use services What the outcome says This is what people who use services should expect. People who use services: * Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights. What we found The provider is compliant with Outcome 04: Care and welfare of people who use services Our findings What people who use the service experienced and told us People that we spoke with said they were happy and settled at Holly Lodge one person told us that they felt well looked after. Other evidence We saw that people looked well groomed and that the laundry staff took pride in making sure people's clothes were ironed and returned promptly to their rooms. We sampled five care plans which were well documented and included how the person liked to receive their care and support over a 24 hour period. People's past occupation and family historys were also included within the care plans and some staff told us that it was always helpful to know what people had done since they retired as this was sometimes a good talking point. We saw that people were seen by a variety of healthcare professionals and the visits were clearly detailed and any changes in the treatment and support of people using the service was documented. We saw that people's body weights were measured, their medication was regualrly reviewed by the person's GP and that care plans contained completed and well documented Mental Capacity assessments. We saw that the care plans included a variety of documented risk assessments such as the risk of falls, moving and handling needs, skin integrity, risk of malnutrition and mobilty to name a few. The assessments detailed the hazards clearly and what measures were in place to keep people as safe as possible. Page 9 of 20

10 We saw that the care plans and risk assessments were regularly reviewed in consultation, where possible, with the person using the service or their representative where possible. The documents provided structure and guidance for staff so that people's current and ongoing care and support needs were met. People using the service receive safe and consistent care and support to meet their individual health and welfare needs. Page 10 of 20

11 Outcome 07: Safeguarding people who use services from abuse What the outcome says This is what people who use services should expect. People who use services: * Are protected from abuse, or the risk of abuse, and their human rights are respected and upheld. What we found The provider is compliant with Outcome 07: Safeguarding people who use services from abuse Our findings What people who use the service experienced and told us We did not speak to people directly about this outcome on this occasion, so cannot report what people using the service said. Other evidence We spoke with a registered manager following the inspection and a care staff member during the inspection in order to check their knowledge and understanding of safeguarding vulnerable people. Both the staff were clear that they would report any concerns they had and both staff demonstrated an awareness of reporting concerns to the local safeguarding authority and then report the matter to the CQC. During our visit we saw that one person had a large bruise on their face and hand. We sought clarification how the bruises had occurred and were informed following the inspection that another person using the service had bumped into the person's chair which had resulted in the person falling to the floor. It was recorded that staff administered first aid and the person was seen by their GP. We sought clarification, as it was not clear at the time of the inspection, as to whether the incident had been reported to safeguarding. It was confirmed that the registered manager had reported the incident and had reviewed the persons risk assessment and an action plan had been developed in order to safeguard the people using the service. Whilst sampling another person's records we found that staff had reported and documented that a person had bruising to their body which had developed over several days. The head of care told us that she had investigated the cause of the bruising Page 11 of 20

12 which had, we were told, been caused by the person having a fall. It was confirmed that the person had had a fall yet the accident had not been reported by the registered agency nurse when it occurred using the homes reporting procedures. Additionally the local safeguarding authority had not been informed regarding the unexplained bruising. During the visit the head of care was asked to refer the incident to the local authority safeguarding team and we observed that there was a delay in the reporting as the local authority contact details with their protocols could not be located. Following the inspection we spoke with the registered manager who confirmed that a safeguarding flowchart was available in the service and a copy had been sent to the CQC following the inspection. We also received an updated copy of the organisations policy and procedure related to safeguarding vulnerable adults. We saw records that the service did provide some statutory notifications to the commission as per the requirements of the essential standards of quality and safety. The registered manager confirmed that all existing staff and newly appointed staff had or were receiving safeguarding training. People who use the service are protected by a staff team that have received training to enable them to recognise and respond to safeguarding concerns. Page 12 of 20

13 Outcome 09: Management of medicines What the outcome says This is what people who use services should expect. People who use services: * Will have their medicines at the times they need them, and in a safe way. * Wherever possible will have information about the medicine being prescribed made available to them or others acting on their behalf. What we found The provider is compliant with Outcome 09: Management of medicines Our findings What people who use the service experienced and told us We talked to one person's relative and were told that they were 'very happy' with the care their relative received at the service. However this was general care and she said she could not comment on medication as she never visited at medication administration times. We were told that their relative had gone through a depressive stage and was now they were better due to changes in their medication. Other evidence A CQC Pharmacy inspection was conducted on the 23rd November It was reported that the home has good facilities to store medicines and systems are in place to record medicine received, disposed and used and this would allow for an audit if necessary. However, we saw several examples where there were gaps on the medicine administration record [MAR] sheets, where we would expect to see a signature for medicines given. We found that these medicines were not in stock when checked which probably means the medicine was given but not signed as given. When we arrived into the office we saw two nurses signing for medicines already given for several people all together in one go. We asked about this practice indicating it is not accepted as safe practice and the nurses were very apologetic confirming that they did know this was not considered safe practice. Page 13 of 20

14 There was a standard information sheet for medicines to be given only if needed. This was not individualised for consistency. For one person there was an individual care plan for challenging behaviour medicine. This information was recorded within the doctor's visit notes and not readily available to staff. When medicines were given with food there was a 'best interest' document signed by healthcare professionals and the relatives. For some people this was available but not dated. During our visit on the 15th December 2011 we saw evidence in the form of formal documentation, observation of nurses administering medicines and sampled several people's medication administration charts to confirm that the shortfalls identified had been addressed. The service protects people against the risks associated with the unsafe use and management of medicines. Page 14 of 20

15 Outcome 13: Staffing What the outcome says This is what people who use services should expect. People who use services: * Are safe and their health and welfare needs are met by sufficient numbers of appropriate staff. What we found The provider is compliant with Outcome 13: Staffing Our findings What people who use the service experienced and told us Several people told us the staff were kind. Other evidence We saw that both floors of the service had a written shift plan for staff and that staff were allocated each day to support specific people who needed their assistance. The staff told us that they felt that the shift was organised and we saw that staff spoke with the registered nurses if any of the plans for the shift needed to be changed. There were clear lines of responsibility and we saw that the staff worked well as a team and this had a positive impact on the people they supported as the shift was well structured and predicable. The staff demonstrated knowledge of the people they were supporting and showed they had the skills and experience to meet the health, safety and welfare needs of people in their care. We spoke with some staff and they said they liked their job and felt they did it well and were valued by the registered manager. Staff work in an organised way to offer continuity of care to ensure the health, safety and welfare of people using the service. Page 15 of 20

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17 Outcome 16: Assessing and monitoring the quality of service provision What the outcome says This is what people who use services should expect. People who use services: * Benefit from safe quality care, treatment and support, due to effective decision making and the management of risks to their health, welfare and safety. What we found The provider is compliant with Outcome 16: Assessing and monitoring the quality of service provision Our findings What people who use the service experienced and told us We did not speak to people directly about this outcome on this occasion, so cannot report what people using the service said. Other evidence During our visit, we observed people being spoken with and supported in a sensitive, respectful and professional manner. This included assessment of their satisfation and having their needs met. Information about people's experiences had been gathered in such a way to allow for monitoring of risks and the quality of care delivery. Complaints, compliments and incidents were recorded and reviewed. The registered nurses confirmed that any identification of trends would be highlighted and lessons arising from these would be used to make changes to the service. The management structure for decision making and accountability provided guidance for staff, to ensure that people's care and support needs were met consistently and safely. We were assured that the quality of the service was monitored and concerns addressed appropriately. Page 17 of 20

18 The provider has arrangements in place to ensure that people who use the service are safe. The quality of care provision is monitored and improvements made when concerns are raised. Page 18 of 20

19 What is a review of compliance? By law, providers of certain adult social care and health care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The Care Quality Commission (CQC) has written guidance about what people who use services should experience when providers are meeting essential standards, called Guidance about compliance: Essential standards of quality and safety. CQC licenses services if they meet essential standards and will constantly monitor whether they continue to do so. We formally review services when we receive information that is of concern and as a result decide we need to check whether a service is still meeting one or more of the essential standards. We also formally review them at least every two years to check whether a service is meeting all of the essential standards in each of their locations. Our reviews include checking all available information and intelligence we hold about a provider. We may seek further information by contacting people who use services, public representative groups and organisations such as other regulators. We may also ask for further information from the provider and carry out a visit with direct observations of care. When making our judgements about whether services are meeting essential standards, we decide whether we need to take further regulatory action. This might include discussions with the provider about how they could improve. We only use this approach where issues can be resolved quickly, easily and where there is no immediate risk of serious harm to people. Where we have concerns that providers are not meeting essential standards, or where we judge that they are not going to keep meeting them, we may also set improvement actions or compliance actions, or take enforcement action: Improvement actions: These are actions a provider should take so that they maintain continuous compliance with essential standards. Where a provider is complying with essential standards, but we are concerned that they will not be able to maintain this, we ask them to send us a report describing the improvements they will make to enable them to do so. Compliance actions: These are actions a provider must take so that they achieve compliance with the essential standards. Where a provider is not meeting the essential standards but people are not at immediate risk of serious harm, we ask them to send us a report that says what they will do to make sure they comply. We monitor the implementation of action plans in these reports and, if necessary, take further action to make sure that essential standards are met. Enforcement action: These are actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers are set out in the law and mean that we can take swift, targeted action where services are failing people. Page 19 of 20

20 Information for the reader Document purpose Author Audience Further copies from Copyright Review of compliance report Care Quality Commission The general public / Copyright (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Quality Commission Website Telephone address Postal address enquiries@cqc.org.uk Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Page 20 of 20